Future Options and Recommendations for Our Island Home and Senior Citizen Related Services Our Island Home Work Group July 2013
The Work Group met from October 2012 thru June 2013 to complete its analysis and formulate its recommendations Work Group Mission Work Group Members • • Future options and recommendations Joe Agiuar Jim Kelly regarding OIH and associated town- • Rachel Chretien Pam Meriam operated senior citizen-related services. • Chuck Gifford Bruce Miller • Review reports, data, documents and • Bruce Glass Mickey Rowland other information that are on hand. • Phil Hubbard David Worth • Review, discuss and make recommendations pertaining to Riverwood /Servant’s (to be delivered) status report to the Board of Selectmen as to the Senior Day Care program. • Discuss pros, cons, costs and revenues of current delivery systems of the local organizations that provide senior citizen- related services. • Review and discuss the Town’s lease with Sherburne Commons, in terms of long- term planning Our Island Home Work Group July 2013
The status quo is not a viable long (or even short term) strategy for OIH . Building is outdated and in need of extensive Demographics are inexorable. Longer life repair; Dept. Public Health citations in 2013 expectancies; traditional family caregivers a over physical conditions thing of the past % Nantucket Population 65+ OIH 2X Average Age of Facilities in Northeast 20% Nationwide 10.5% growth in 65+ Northeast island population; 15% trend similar for 75+ Our Island Home population 2000- 2010 0 10 20 30 40 10% Years 2000 2010 Source: 27 th Annual Licensed Nursing Facility Cost Comparison Larson Allen, LLP. 2010 Sources: 2000 SF1 P23, P24, P25; 2010 SF1 P26 Analysis by P. Morrison Our Island Home Work Group July 2013
The nature of skilled nursing care, how it is paid for, and the federal and state reimbursement structure for skilled nursing is changing Reimbursement trend toward redirecting Mass Health – Medicaid is the predominate payments away from institutional settings like payer source for OIH putting future revenue OIH and toward Home and Community Based at risk as reimbursement trends shift . Services which can be provided at a lower cost. Ave 2011-2012 2000 2012 Growth Rate $ 6% 1% Mass Nursing 57% of 43% 28% Health Facilities total $ ICF/MR 15% 11% 1.8% Private pay 25% Home/Com 18% 33% 210% munity Medicare Based 68% Personal 10% 14% 133% care/Home Other Health Source: CMS Medicaid Statement of Expenditures (CMS-64) 2000, CMS Medicaid Program Budget report Source: OIH Operating statements. OIH WG Analysis (CMS-37) August 2010 & 2011, Annual Estimate 2012. Figures in $ Billion Our Island Home Work Group July 2013
Revenue/Reimbursements from all sources not keeping up with operating expenses. 80% of OIH operating costs are labor related Total labor cost at OIH is 67% $8,000 $450 higher than the top 10% of all $400 nursing facilities in the Northeast $7,000 $350 $6,000 $300 Rate per Day $5,000 Total Labor $300 $250 Cost $4,000 $200 $200 $3,000 Salary/Wage $150 Costs $2,000 $100 $100 $1,000 Payroll tax & $50 Fringe $0 $0 $0 benefits 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 OIH Northeast Top Decile Revenue Expense Rate per Day Source: Town of Nantucket Historical Financials Cost Report 27th Annual Licensed Nursing Facility Cost Comparison Larson Allen, LLP. 2010 Our Island Home Work Group July 2013
The WG’s conclusions have been drawn around six categories . These conclusions have gone into the formulation of our recommendations. At the core of our conclusions is the recognition that the model must change in order for Our Island Home to deliver skilled nursing care to the community in the future Facility Reimbursements People Shared Services Alternatives Community Our Island Home Work Group July 2013
The WG’s recommendations call for a shift to a community based care model with a new, modular OIH to meet the institutional needs of the community Co-locate at Sherburne Commons or hospital; build in modular fashion; New OIH share non-medical services Skilled Entity to Community Nursing coordinate Based Care Home community Health senior Model Care services Provided in home and delivered thru OIH Monetize existing OIH site Source of financial resources to support recommendations Our Island Home Work Group July 2013
What’s Next? How do we get from here to there? How Do We Do It? What Should Develop We Do? implementation plans Alternatives Begin analysis What Can Implementation Community We Do? Commentary Identify Policy alternatives decision(s) TM January + 2014 October-June 2013 July – April 2014 Our Island Home Work Group July 2013
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